Individual
DR. JOHNATHAN T FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
2318 FREDERICA ST, OWENSBORO, KY 42301-4826
(270) 686-7873
(270) 686-7864
Mailing address
2318 FREDERICA ST, OWENSBORO, KY 42301-4826
(270) 686-7873
(270) 686-7864
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
015034
KY
Other
Enumeration date
09/23/2011
Last updated
09/23/2011
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